4.6 Article

Management, Clinical Outcomes, and Complications of Shield Ulcers in Vernal Keratoconjunctivitis

Journal

AMERICAN JOURNAL OF OPHTHALMOLOGY
Volume 155, Issue 3, Pages 550-559

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajo.2012.09.014

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Funding

  1. Hyderabad Eye Research Foundation, Hyderabad, India

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PURPOSE: To assess the clinical outcomes and complications of shield ulcers by various treatment methods. DESIGN: Retrospective, interventional case series. METHODS: SETTING: Cornea and anterior segment service of L.V. Prasad Eye Institute, India. STUDY POPULATION: One hundred ninety-three eyes of 163 patients clinically diagnosed with vernal keratoconjunctivitis and shield ulcers. INTERVENTION: The treatment algorithm was based on the Cameron clinical grading of shield ulcers. Grade 1 ulcers received medical therapy alone. Grade 2 and grade 3 ulcers received either medical therapy alone or medical therapy combined with debridement, amniotic membrane transplantation (AMT), or both. MAIN OUTCOME MEASURES: Re-epithelialization time and best-corrected visual acuity. RESULTS: Grade 1 ulcers were seen in 71 (37%) eyes, grade 2 ulcers were seen in 79 (41%) eyes, and grade 3 ulcers were seen in 43 (22%) eyes. In the grade 1 group, re-epithelialization was seen in 67 (94%) eyes. In the grade 2 group, re-epithelialization was seen in 36 (88%) eyes that received medical treatment, in 20 (95%) eyes that underwent debridement, and in 17 (100%) eyes that underwent AMT. In the grade 3 group, re-epithelialization was seen in only 1 (1.7%) eye that received medical treatment, whereas it was seen in all eyes that underwent debridement and AMT. The mean best-corrected visual acuity after re-epithelialization of the shield ulcer was 20/30, 20/30, and 20/40 in the grade 1, grade 2, and grade 3 groups, respectively. Recurrence and secondary bacterial keratitis were seen in 28 (14.5%) and 20 (10%) eyes, respectively. CONCLUSIONS: Grade 1 shield ulcers respond well to medical therapy alone, whereas grade 2 ulcers occasionally may require additional debridement or AMT. Grade 3 ulcers, however, largely are refractory to medical therapy and require debridement and AMT for rapid re-epithelialization. (Am J Ophthalmol 2013;155:550-559. (C) 2013 by Elsevier Inc. All rights reserved.)

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